I-Transcutaneous pacing iyanzima kunokuba ibonakala.
Enye yezinto ezinzulu kwiinkqubo zonyango olungxamisekileyo lwe- bradycardia ephawulekayo kukunyathela ukulawulwa kwe-atropine kunye nokuzula ngqo kwi-pacing yangaphandle. Kukhethwa ngokuqhelekileyo phakathi kwee- paramedics . Ukucinga kukuba i-atropine ibangela ukuba i-oksijeni iyancipha ifuna ukuba ixinzeleleke ingcinezelo entliziyweni kwaye ingakhokelela kwisifo se- myocardial infarction .
Kunoko, ukucinga kuhamba, sebenzisa i-transcutaneous pacing ukunyusa izinga lentliziyo ngaphandle kwemiphumo emibi ye-atropine.
Ngaphandle kokungena kwingxoxo malunga nokuba ngaba kukhethwe ngokufanelekileyo okanye akunjalo, kubalulekile ukuqaphela imingxuma yokusebenzisa i-transcutaneous pacing yangaphandle. Kude kumgama we-panacea. Inkqubo ephezulu-acuity, low-frequency inkqubo eyenza ngaphezu kwesabelo sayo sokudideka kwimeko engxamisekileyo. Ukuhamba kakuhle ngesigulane kwi-bradycardia ephawulekayo, umntu kufuneka aqiniseke ukuba uyayiqonda ngokupheleleyo i-mechanics kunye nokusetyenziswa kwekliniki ye-pacemaker yangaphandle.
Imbali yePacing
Okokuqala, abavusi beentliziyo baye bajikeleza ngokude njengoko intliziyo yomntu ikhona. Kuza kunye nabakhuthazayo bemvelo -bonke, isistim se-cardiac muscle sinokuzalisekisa le nxaxheba xa kuyimfuneko-kodwa ukusetyenziswa kombane okubangela ukuqhaqha kwentliziyo kuye kwavela ukususela ekupheleni kwe-1700s, nangona amaxoxo.
Iimpawu zengqondo zonyango zithatha indawo yekliniki kwiminyaka ye-1900 kwaye sele ihamba encinci kwaye ihlakaniphile. Kukho abanikezeli be-pacemakers abasetyenziselwa izigulane ezineengqungquthela ezingapheliyo ze-cardiac arrhythmias. Ukusetyenziswa kwezigulane zangaphandle zetranshana ezisebenzisa i-electrodes ezifakwe kwiimpawu zokubambelela ziye zasebenziswa ngaphakathi nangaphandle kwesibhedlele ukususela ngo-1985.
Umshini
Kukho imveliso emininzi kunye neemodeli ze-paccutakers zangaphandle, kodwa zilandela zonke izinto eziphambili. I-monitor ye-cardiac enokubakho ubuncinci, eqhubekayo, ebonakalayo enye- electrocardiogram (ECG) idibene ne-pacemaker ezayo enee-electrode ezimbini. I-electrode idla ngokufakwe kwi-single-use, i-pre-gelled adhesive pads. Kwimizekelo yamaninzi anamhlanje, isahlulo se-pacemaker kunye neepads ezimbini njenge- defibrillator .
Uninzi lwazo ziza kunye nomshicileli ukurekhoda isigqi sesigulane se-ECG kunye nayiphi na imizamo yokunyuka okanye ukuyibeka phantsi. Amacebo amaninzi anakho okunye okubalulekileyo okubekwe esweni, njengengcinezelo yegazi engeyiyo (invasive blood pressure) (NIBP), i- pulse oximetry , i-end-tidal capnography, njl. Kukho ezinye iinkcazo esinokuzenza ngokusebenzisa le miqondiso ebalulekileyo ekuncedeni ukuchonga okufanelekileyo. Oku ngakumbi kule kamva.
Iimpawu zentsimbi ezithintekayo zineendlela ezimbini ezinokuguqulwa ngumgcini-nkonzo: amandla ombane kunye nomyinge weempembelelo ngomzuzu. Ixabiso lihle kakhulu lichaza. Le yonyango ye-bradycardia ephawulekayo, ngoko ukulungiswa kwemilinganiselo kufuneka kube msinya kunokuba isigulane sogulane. Ngokuqhelekileyo, sidulela inani eli malunga ne-80 ngomzuzu. Oku kuyahluka ngendawo, ke qiniseka ukuba uhlolisise nomlawuli wakho wezobukhokelo ukuze ufumane isikhokelo kwisantya esifanelekileyo sokuhamba.
Amandla okugulisa amandla kagesi alinganiswa ngama-milliamperes (i- milliamps kulabo baziyo). Kuthatha inani elincinci lamanzi ukugqithisa umgca wesigulane ukuze kubangele ukubetheka. Lo mbundu uhlukile kwiigulane kunye neyona mpazamo eqhelekileyo ekusebenziseni i-pacemaker ye-transcutaneous ihluleka ukukhwela amandla aphezulu ngokwaneleyo. Ukwenza izinto zibe nzima nakakhulu, kunemiqathango eyahlukeneyo yeendlela zokuqhuba intliziyo kunye nentliziyo yesisu, oko kuthetha ukuba i-ECG ibonakala ngathi i-pacemaker isebenza, kodwa i-heart muscle ayiphenduli.
Ukufakela iCandelo
Umzekelo ngamnye uhlukile kwaye kubalulekile ukuba umncedisi ngamnye uzinike ixesha lokuziqonda ngecebo eliza kulusebenzisa ensimini. Oko kuthethwa, iinkqubo zifana kakhulu kwiimpawu ezininzi.
Iipasta ze-pacer mazifakwe kunye ne-electrodes yokubeka iliso. Xa i-transcutaneous pacemakers kunye ne-defibrillators zixhobo ezihlukeneyo, i-pacer ipads kufuneka ikhutshwe ngendlela ye-paddles ifowuni ngokubanjwa, ukukhathazeka ngokusemthethweni xa udlala nge-patient's system system. Ngoku ke abaninzi abanokukhupha i-transcutaneous doubleemaker njengabadlali be-defibrillators, ama-patches athatyathwa ngokufanayo kwizinto zombini zisebenzisa. Kwakhona, landela izikhokelo zomenzi.
Isigulane kufuneka sidibaniswe kweso sigxina senhliziyo. Oku kubalulekile. Kulabo baqhelaniswe nendlela yokusebenzisa i-cardiac defibrillators esebenza ngayo, kuyiphutha eliqhelekileyo ukucinga ukuba i-electrodes ye-pacemaker (i-pacer pads) iya kuba nako ukubeka esweni isigulane senhliziyo yesigulane. Yiyo indlela abadlali be-defibrillators basebenza ngayo, kodwa i-defibrillators ihambisa ukutshatyalaliswa okukodwa, kwaye ubuyele ekuhloleni isigqi. I-pacemaker ye-transcutaneous iqhuba ngokuqhubekayo iimpembelelo kwaye ayinayo ithuba lokubeka iliso nantoni na ngokusebenzisa i-pacer ipads.
Qinisekisa ukuba i-monitor ye-ECG isetyenziswe ukuba ifunde ukukhokela ngokusebenzisa i-electrodes yokubeka iliso kwaye ingabi nge-packer pads. Ngenxa yokuba i-defibrillator / pacemaker esebenzisana nayo isebenzisa iifayile ezifanayo zombini zonyango, kulula kakhulu ukuyibeka ngokungafanelekanga. Ukuba isetyenziselwe ukufundwa ngeepad, amacebo amaninzi awanakusebenza xa ukuzama ukuzama.
Phakamisa Umonde
Emva kokuba ifowuni isetyenziswa ngokufanelekileyo kwaye isebenze, khangela i-speres zokuhamba kwi-ECG ukulandelela. Xa sinawo, sekuyisikhathi sokunyamezela isigulane:
- Beka izinga kwiinqwelo ezifunwayo ngomzuzu. Uninzi lwamadivaysi alukhoyo kwizinga phakathi kwama-70-80, kodwa izinga lilungiswa ngumgcini-nkonzo.
- Ukwandisa izinga lamandla kude kube nezimpembelelo zenze i-QRS eyinkimbinkimbi, eyaziwayo njengeyithinjwa. I-monitor ye-ECG iya kubonisa i-spike eqinileyo yentshukumo nganye kwaye xa i-spike nganye ilandelwa ngokukhawuleza nge-complex QRS, ukubanjwa kuthathwa (funda umfanekiso ongentla).
- Zivalelwe ngentshukumo ye-radial. Kufuneka kube ne- pulal radial kwi-QRS nganye, okanye le nto ayinakunceda. Ukuba isigulane asiyikuchukumisa i-pulsal radial, uxinzelelo lwegazi lusezantsi kakhulu ukuba luzinzileyo.
- Bump up energy 10 milliamps kudlulileyo kwinqanaba lokubamba. Oku kunciphisa amathuba okulahlekelwa ekubanjweni kwixesha elizayo.
Emva kokuba i-pacemaker isebenza kwaye imeko yesigulane iphucula, qwa lasela. Le nto ibuhlungu njengento ephosa. Kuza kuba nobuninzi bomfutho we-squelet of the wall of the chest nganye. Isigulane sinokuyinyamezela imizuzu embalwa, kodwa kungekhona ixesha elide. Ukuba le nto isetyenziselwa kwintsimi, isigulane sisadingeka sithunyelwe esibhedlele ngaphambi kokuba into eninzi ingabonakaliyo (kwaye ibuhlungu kakhulu) inokuthi ithathe indawo ye-pacemaker ye-transcutaneous.
Izibongo zeCrosscutaneous Pacing
Amagama amathathu: Thatha! Thatha! Thatha! Iphutha eliqhelekileyo endilibonayo kwisicelo se-transcutaneous pacemaker yesibhedlele ukuhluleka ukubamba. Isizathu esona sikhulu sichaza i-ECG kwaye sikholelwa ukuba ukuthunjwa kwenzeka.
Xa i-spikes ye-pacer ibonakala ibetha kakuhle phambi kokuba i-QRS idibanise, inokubonakala ngathi isixhobo sinceda (bona umfanekiso ophezulu). Kukho izikhombisi ezimbalwa zokunceda ukuphepha le mpazamo:
- Thelekisa isantya esandulelayo kunye nento umnakekeli akholelwa ukuba isigqi "esincinci". Ukubanjwa kwangempela kuza kubonakalisa ukwakheka okwehlukeneyo kwe-QRS ingxaki kuba i-focal point of impulse ivela kwindawo eyahlukileyo (i-patch enkulu kwi-esifubeni esinkulu njengentliziyo kunokuba ithethe indawo kwindawo yokuqhuba i-cardiac). Ukuba ukubunjwa kweQRS akutshintshi, ukuthathwa akunakwenzeka.
- Ukuba i-pacer igxininisa ngaphezu kwe-QRS complexes, asizange siphumelele ukubanjwa kwangoku. Kulo mfanekiso ungentla, kukho iipikisi ezintathu, kodwa zimbini kuphela ii-QRS ezinqamlekileyo kwinxalenye yomtya ngaphandle kokubanjwa.
- Ukuba i-spikes ye-pacer ihamba kwimida eyahlukahlukileyo ukusuka kwi-QRS complexes, akukho kubanjwa.
- Ukuba amandla angaphantsi kwezi-40 zama-milliamps kwisigulane somntu omdala, akunakwenzeka ukuba ukuthunjwa kwenzeka. Uninzi lwezigulane lunomyinge ngaphezulu kweli nqanaba. Yenza i-notch. Uninzi lweefowuni lunyuse amandla kumanqanaba amahlanu okanye ama-milliamp increments.
I-QRS nganye yeentonga; eureka! Sithathile!
Akunjalo ngokukhawuleza ... ngaba sine-pulse kunye na? Ukuthunjwa kwamandla kuboniswe kwi-ECG, kodwa ukuthunjwa ngokomzimba kuhlolwa ngeempawu ezibalulekileyo. Iphutha lesibini eliqhelekileyo kakhulu ndilibona ukungaphumeleli kokuqinisekisa ukuthunjwa ngokomzimba. Khangela le miqondiso:
- I-pulal ye-radial nganye ye-QRS yikhombisi engcono. Oku kuxelela umnakekeli ukuba ukuphambana komzimba ngamnye kufinyelela ingcinezelo yegazi ye-systolic okungenani 80-90 mmHg.
- I-hick yezigulane ezinzima kukujonga i-pulse ye-oximetry form form. Ukuba ifom ye-waveform iyafana nereyithi ye-QRS- ekufuneka ibe yizinga elibekwe kwisixhobo, okanye asibambanga-ke siyazi ukuba intliziyo iyakwenza i-QRS nganye. Thatha uxinzelelo lwegazi ukuze ubone ukuba uxinzelelo luzinzileyo. Ukuba liphantsi, i-bolus ye-fluus inokusinceda ukulungisa ingxaki. Qinisekisa ukuba uqhagamshelane nezikhokelo zonyango.
Gwema ukusebenzisa i-carotid pulse njengombawuli wokubanjwa kwangokwenyama. Iziphambano zomzimba ezinamaqabunga eziza kunye nokuhamba ngokukhawuleza kwenza ukuba kunzima ukufumanisa iziphazamiso ze-carotid. Balapho, kodwa mhlawumbi kungekhona ngokukhawuleza nje nge-pacer, esona sizathu esithile sokujonga ipulse kwindawo yokuqala.
Okokugqibela, phatha intlungu. Kukho umzekelo omnye umguli ogcina ukutshisa ukusuka kwizigulane ze-pacer kunye nezigulana phantse ngokubanzi zikhalaza iintlungu ezisuka kwi-skeletal muscle stimulation nge-transcutaneous pacing.
> Imithombo:
> Bocka, J. (1989). Izicathulo zangaphandle ze-transcutaneous. I-Annals yoMnxeba oPhezulu , 18 (12), 1280-1286. i-doi: 10.1016 / s0196-0644 (89) 80259-8
> Muschart, X. (2014). Ukutshisa ukuba kuphile: inkxalabo yokuvuselela kwimizimba ye-cardiac. Unonophelo oluBalulekileyo , 18 (6). I-doi: 10.1186 / s13054-014-0622-x